Provider Demographics
NPI:1437331238
Name:KATHY SANTORIELLO MD PA
Entity Type:Organization
Organization Name:KATHY SANTORIELLO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANTORIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-419-0505
Mailing Address - Street 1:6860 SE HARBOR CIR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-1968
Mailing Address - Country:US
Mailing Address - Phone:772-419-0505
Mailing Address - Fax:772-781-7327
Practice Address - Street 1:900 SE OCEAN BLVD
Practice Address - Street 2:SUITE 330 D
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2471
Practice Address - Country:US
Practice Address - Phone:772-419-0505
Practice Address - Fax:772-781-7327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68461174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43005OtherBCBS
FL43005OtherBCBS
FLK6467Medicare PIN